A note on the language used in woman of substances

If you’re interested in the language we use to describe drug and alcohol use, join me on this overthink.

It’s a bit of a dilemma, being interviewed about Woman of Substances and hearing ‘alcoholic’, ‘addict’, ‘addiction’ and ‘abuse’ used freely by the journalist. In the introduction of the book, there’s a note on language:

The language of drug and alcohol use depends on what school of thought you align with. In the US, where treatment is predominantly based around abstinence, terms such as ‘alcoholic’, ‘addiction’, ‘substance abuse’, ‘sober’ and ‘recovery’ are used, and have infiltrated the policy of many other countries.

In Australia, where drug strategy is based around harm minimisation, the preferred language is: ‘person affected by drug use’, ‘drug-related harm’, ‘giving up’, and ‘level of dependence’. These are terms that don’t create an us-versus-them divide.

I personally don’t call myself an ‘alcoholic’ or – to coin an increasingly popular phrase in the US – ‘identify as an addict’, because surely accepting a label disregards every other part of our multifaceted selves and keeps us forever in a box. I’m also far too English to use a dramatic term such as ‘in recovery’. However, on the cover of this book I use the term ‘addiction’ because it is less laboured than the alternatives.

The thing is, of all the words under debate, ‘addiction’ is perhaps the trickiest one, since it doesn’t necessarily stigmatise the subject. It’s just a bit… vague.

Many of my academic interviewees coached me on language during the writing of this book, including Professor Steve Allsop, the director of the National Drug Research Institute. He said:

“I’m uncomfortable about the term ‘addiction’ because it means different things to different people. One of my colleagues has just given me a report they’ve written and I’ve struck out ‘addiction’ all the way through because it’s ill-defined. Instead I inserted ‘severity of dependence’, which has a clinical meaning.”

And here’s Kristen Gwynne, a founding editor of The Influence (a site about our relationship with drugs), on why she bucks the US trend of using labels.

“Like all psychological diagnoses, ‘addiction’ represents clusters of symptoms that are extensions of our personalities. There are factors like repeated and unsuccessful attempts to quit; hurting relationships; jobs; withdrawal, etc, that are used in research to identify patterns and avoid a wide net. Drug use is a spectrum, and the black-and-white rhetoric about ‘addicts’ doesn't represent that. Understanding that there are differences in drug use, even if it's just tolerance/dependence/addiction/abstinence, teaches us about mitigating and risk factors that can help (or hurt) people. Not everyone who uses drugs or alcohol to their detriment experiences addiction, and not all people who experience the most extreme consequences of addiction require abstinence to prevent relapse – but all we say is ‘addict’ or if you're lucky ‘recovering addict’."

I’m a core member of AOD Media Watch, a group that makes a point of highlighting stigmatising language (such as 'addict', 'junkie', 'alcoholic') in the news. But there’s still no hardline consensus on ‘addiction’ in the Australian treatment industry. For example, I recently attended the Australian and New Zealand Addiction Conference. And one academic who’s very pro not using ‘addiction’ is head of an ‘Addiction’ department – much to his annoyance.

Back to publicising Woman of Substances, and I’m wondering when to be pedantic and when to hold back. Can I accept journalists calling my alcohol use ‘addiction’ when I managed to quit without medical supervision? If I insist on an alternative, will readers fall asleep before they even get to the end of the phrase ‘problematic substance use’? Should I point out that, as Allsop says, the only way I could have ‘misused’ alcohol would have been to clean my car with it? Isn't 'abuse' something perpetrators do?